The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO) on the training of emergency medicine residents (EMR) is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS). The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05%) shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008). The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs

Effect of Positive End-Expiratory Pressure on Central Venous Pressure in Patients under Mechanical Ventilation

Introduction: Finding the probable governing pattern of PEEP and CVP changes is an area of interest for in-charge physicians and researchers. Therefore, the present study was designed with the aim of evaluating the relationship between the mentioned pressures. Methods: In this quasi-experimental study, patients under mechanical ventilation were evaluated with the aim of assessing the effect of PEEP change on CVP. Non-trauma patients, over 18 years of age, who were under mechanical ventilation and had stable hemodynamics, with inserted CV line were entered. After gathering demographic data, patients underwent 0, 5, and 10 cmH2O PEEPs and the respective CVPs of the mentioned points were recorded. The relationship of CVP and PEEP in different cut points were measured using SPSS 21.0 statistical software. Results: 60 patients with the mean age of 73.95 ± 11.58 years were evaluated (68.3% male). The most frequent cause of ICU admission was sepsis with 45.0%. 5 cmH2O increase in PEEP led to 2.47 ± 1.53 mean difference in CVP level. If the PEEP baseline is 0 at the time of 5 cmH2O increase, it leads to a higher raise in CVP compared to when the baseline is 5 cmH2O (2.47 ± 1.53 vs. 1.57 ± 1.07; p = 0.039). The relationship between CVP and 5 cmH2O (p = 0.279), and 10 cmH2O (p = 0.292) PEEP changes were not dependent on the baseline level of CVP. Conclusion: The findings of this study revealed the direct relationship between PEEP and CVP. Approximately, a 5 cmH2O increase in PEEP will be associated with about 2.5 cmH2O raise in CVP. When applying a 5 cmH2O PEEP increase, if the baseline PEEP is 0, it leads to a significantly higher raise in CVP compared to when it is 5 cmH2O (2.5 vs. 1.6). It seems that sex, history of cardiac failure, baseline CVP level, and hypertension do not have a significant effect in this regard

Diagnostic stability among patients readmitted with serious mental illnesses in a referral psychiatric university hospital in Tabriz, Iran,in 2016

Introduction: Regarding mental disorders, one of the important factors in the validity of clinical diagnosis is its consistency in consecutive evaluations. This varies from 29% in personality disorders to 70% in schizophrenia. This survey was conducted to study clinical diagnosis stability among readmitted patients in referral psychiatric university hospital. Methods: In this study, 1000 records were evaluated retrospectively. Data were gathered by educated clinical psychologist with a prepared checklist. The checklist consisted of demographic data, clinical interview data, primary and final diagnosis, and process of care. The collected data were analyzed using SPSS software and presented as descriptive and proportion measures. Results: The mean age of patients in the first hospitalization was 31.23 years. Since the first admission, 26.6% of patients’ life time was spent in hospitals. The clinical diagnosis of cases at discharge was bipolar mood disorder I (BMD I) and schizophrenia in 49.5 and 40.4 percent of cases, respectively. Generally, concordance between admission and discharge diagnosis was 94.9 and 84.4 percent among the women and men, respectively. 66.0% of patients with BMD I and 71.4% of patients schizophrenia received the same diagnosis in at least 75% of their next hospital admissions. Furthermore, the prospective consistency was 80 and 60 percent in schizophrenia and BMD I, respectively. Conclusion: The findings of the present study showed that in psychiatric studies, clinical diagnosis can be challenging especially in short term evaluations

تطابق برنامه های بازآموزی های برگزار شده در حوزه طب اورژانس با سرفصل های ضروری آموزشی در این رشته

Introduction: Currently, there is a lack of data on the agreement between the continuous medical education (CME) programs and the necessary training topics in the field of emergency medicine in Iran. The present study aimed to evaluate the mentioned agreement in CME programs held during 2010-2014, all over the country. Methods: In the present cross-sectional study, the data recorded regarding emergency medicine-related CME programs were extracted from continuous training database of the Ministry of Health. Then, 30 items from the most important topics taught in emergency medicine training were selected by 3 emergency medicine specialists. Subsequently, the agreement of the selected training topics and CME programs was evaluated regarding duration of training, annual changes, and efficiency. Results: During 2010-2014, a total of 10147 hours of CME programs were held in relation to emergency medicine topics in Iran, which were most frequently (1015 hours) related to surgical emergencies. The next most frequent emergency-related CME programs were in the fields of toxicology with 810 hours (8.0%), neurology with 700 hours (6.9%), pediatric emergencies with 695 hours (6.8%), internal medicine with 675 hours (6.7%), and cardiopulmonary resuscitation with 555 hours (5.5%). In addition, it was determined that none of the CME programs were in complete agreement with the expected standards. Cohen’s kappa test showed that the agreement between the current conditions of CME programs with the standard was only 46.7% (95% confidence interval: 40.9 – 52.55) which shows a weak agreement (p = 0.19). Conclusion: The findings of the present study show the weak agreement of the CME programs held in the field of emergency medicine with the expected standards. مقدمه: در حال حاضر اطلاع دقیقی از میزان تطابق دوره های بازآموزی رشته طب اورژانس با سرفصل های ضروری آموزشی این رشته وجود ندارد. لذا مطالعه حاضر در نظر دارد تا میزان تطابق بازآموزی های برگزار شده طی سال های 1389 تا 1393 با سرفصل های آموزشی رشته تخصصی طب اورژانس را مورد بررسی قرار داد. روش کار: در مطالعه مقطعی حاضر اطلاعات ثبت شده از بازآموزی های مرتبط با رشته تخصصی طب اورژانس از سامانه آموزش مداوم وزارت بهداشت جمع آوری گردید. سپس 30 آیتم از مهمترین مباحث آموزشی رشته طب اورژانس با نظر 3 متخصص طب اورژانس انتخاب شد و اقدام به ارزیابی تطابق بازآموزی ها از لحاظ مدت زمان آموزش، روند تغییرات سالیانه و کفایت با سرفصل های آموزشی رشته طب اورژانس گردید. يافته ها: طی سال های 1389 تا 1393 به طور مجموع، 10147 ساعت بازآموزی مرتبط با سرفصل های آموزشی رشته طب اورژانس ارائه شده بود. بیشترین فراوانی (1015 ساعت)  بازآموزی ها مرتبط با اورژانس های جراحی بود. در رتبه بعدی بازآموزی در زمینه اورژانس مسمومیت با میزان 810 ساعت (8/0درصد) اورژانس های نورولوژیک با میزان 700 ساعت (6/9 درصد)، اورژانس های اطفال با میزان 695 ساعت (6/8 درصد)، اورژانس های داخلی با 675 ساعت (6/7 درصد) و احیا قلبی ریوی با 555 ساعت (5/5 درصد) قرار داشتند. علاوه بر این مشخص گردید که هیچ یک از باز آموزی ها تطابق کامل با استانداردهای مورد انتظار ندارند. آزمون کاپای کوهن نشان داد میزان توافق بین وضعیت موجود بازآموزی ها با استاندارد تنها 46/7 درصد (با فاصله اطمینان 95 درصدی برابر 52/55-40/9) بود که در طبقه موافقت ضعیف قرار می گیرد (0/19=p). نتيجه گيری: یافته های پژوهش حاضر حاکی از توافق ضیف باز آموزی های انجام شده در حوزه طب اورژانس با استانداردهای مورد انتظار بود

Agreement between the Continuous Medical Education Programs and Necessary Training Topics in the Field of Emergency Medicine

Introduction: Currently, there is a lack of data on the agreement between the continuous medical education (CME) programs and the necessary training topics in the field of emergency medicine in Iran. The present study aimed to evaluate the mentioned agreement in CME programs held during 2010-2014, all over the country. Methods: In the present cross-sectional study, the data recorded regarding emergency medicine-related CME programs were extracted from continuous training database of the Ministry of Health. Then, 30 items from the most important topics taught in emergency medicine training were selected by 3 emergency medicine specialists. Subsequently, the agreement of the selected training topics and CME programs was evaluated regarding duration of training, annual changes, and efficiency. Results: During 2010-2014, a total of 10147 hours of CME programs were held in relation to emergency medicine topics in Iran, which were most frequently (1015 hours) related to surgical emergencies. The next most frequent emergency-related CME programs were in the fields of toxicology with 810 hours (8.0%), neurology with 700 hours (6.9%), pediatric emergencies with 695 hours (6.8%), internal medicine with 675 hours (6.7%), and cardiopulmonary resuscitation with 555 hours (5.5%). In addition, it was determined that none of the CME programs were in complete agreement with the expected standards. Cohen’s kappa test showed that the agreement between the current conditions of CME programs with the standard was only 46.7% (95% confidence interval: 40.9 – 52.55) which shows a weak agreement (p = 0.19). Conclusion: The findings of the present study show the weak agreement of the CME programs held in the field of emergency medicine with the expected standards

Intranasal Sufentanil versus Intravenous Morphine Sulfate in Pain Management of Patients with Extremity Trauma

Introduction: Pain is one of the most common complaints of patients referred to emergency department (ED) and its control is one of the most important responsibilities of the physicians. The present study was designed, aiming to compare the efficiency of intranasal sufentanil and intravenous (IV) morphine sulfate in controlling extremity trauma patients' pain in ED. Methods: In the present clinical trial, extremity trauma cases referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2014 to March 2015 were randomly divided into 2 groups treated with intranasal sufentanil (0.3 µg/kg) and IV morphine sulfate (0.1 mg/kg) single-doses. Demographic data and information regarding the quality of pain control such as pain severity before intervention and 15, 30, and 60 minutes after intervention, and probable side effects were gathered using a checklist and compared between the 2 groups. Results: 88 patients with the mean age of 35.5 ± 14.8 years were included in the study (81.8% male). 44 patients received IV morphine sulfate and 44 got intranasal sufentanil. No significant difference was detected between the 2 groups regarding baseline characteristics. In addition, there was no significant difference in the groups regarding pain relief at different studied times (p = 0.12; F = 2.46; df: 1, 86). Success rate of the drugs also did not differ significantly at different studied times (p = 0.52). No significant difference was seen between the groups regarding side effects (p = 0.24). Conclusion: Based on the results of this study, it seems that intranasal sufentanil has a similar effect to IV morphine sulfate in rapid, efficient, and non-invasive pain control in patients with traumatic extremity injuries

مقایسه کارائی سوفنتانیل اینترانازال با مورفین سولفات وریدی درکنترل درد بیماران با ترومای اندام

Introduction: Pain is one of the most common complaints of patients referred to emergency department (ED) and its control is one of the most important responsibilities of the physicians. The present study was designed, aiming to compare the efficiency of intranasal sufentanil and intravenous (IV) morphine sulfate in controlling extremity trauma patients' pain in ED. Methods: In the present clinical trial, extremity trauma cases referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2014 to March 2015 were randomly divided into 2 groups treated with intranasal sufentanil (0.3 µg/kg) and IV morphine sulfate (0.1 mg/kg) single-doses. Demographic data and information regarding the quality of pain control such as pain severity before intervention and 15, 30, and 60 minutes after intervention, and probable side effects were gathered using a checklist and compared between the 2 groups. Results: 88 patients with the mean age of 35.5 ± 14.8 years were included in the study (81.8% male). 44 patients received IV morphine sulfate and 44 got intranasal sufentanil. No significant difference was detected between the 2 groups regarding baseline characteristics. In addition, there was no significant difference in the groups regarding pain relief at different studied times (p = 0.12; F = 2.46; df: 1, 86). Success rate of the drugs also did not differ significantly at different studied times (p = 0.52). No significant difference was seen between the groups regarding side effects (p = 0.24). Conclusion: Based on the results of this study, it seems that intranasal sufentanil has a similar effect to IV morphine sulfate in rapid, efficient, and non-invasive pain control in patients with traumatic extremity injuries. مقدمه: درد از شکایتهای رایج بیماران مراجعه کننده به بخش اورژانس می باشد که کنترل آن از وظایف مهم پزشکان می باشد. مطالعه حاضر با هدف ارزیابی کارایی سوفنتانیل اینترانازال  با مورفین سولفات وریدی در کنترل درد بیماران با ترومای اندام در بخش اورژانس طراحی شده است. روش کار: در کارآزمایی بالینی حاضر موارد ترومای اندام مراجعه کننده به بخش اورژانس بیمارستان امام حسین، تهران، ایران، در بازه زمانی مهر 1393 تا فروردین 1394 به طور تصادفی به دو گروه تحت درمان با سوفنتانیل اینترانازال (0/3 میکروگرم بر کیلوگرم) و مورفین سولفات (0/1 میلی گرم بر کیلوگرم) به صورت تک دوز قرار گرفتند. داده های دموگرافیک و اطلاعات مربوط به کیفیت کنترل درد، شدت درد قبل از مداخله و دقایق 15، 30 و 60 بعد از دریافت دارو و عوارض احتمالی از طریق چک لیستی جمع آوری و بین دو گروه مقایسه گردید. يافته‌ها: 88 بیمار با میانگین سنی 14/8±35/5سال وارد مطالعه شدند (81/8 درصد مرد). 44 بیمار مورفین سولفات وریدی و 44 بیمار سوفنتانیل اینترانازال  دریافت کردند. از نظر اطلاعات زمینه ای تفاوت معناداری بین دو گروه مورد بررسی مشاهده نشد. اختلاف معنی داری در میزان کاهش شدت درد در زمان های مورد مطالعه بین دو دارو مشاهده نگردید (0/12 = p؛ 2/46 = F؛ 86، 1:df). میزان موفقیت درمانی دو دارو نیز در زمان های مورد مطالعه اختلافی معنی داری نداشت (0/52 = p). اختلاف معنی داری بین دو گروه از جهت عوارض دارویی مشاهده نشد (0/24 = p). نتیجه‌گیری: براساس یافته های بدست آمده بنظر می رسد سوفنتانیل اینترانازال در کنترل سریع، مناسب و غیرتهاجمی درد بیماران با آسیب های تروماتیک اثری مشابه مورفین سولفات داخل وریدی دارد و لذا شاید بتواند به عنوان جایگزینی مناسب برای کنترل درد بیماران ترومایی مد نظر قرار گیرد